APPLICATION FOR AN ANNUAL LICENCE

APPLICATION FOR AN ANNUAL LICENCE

SECTION 1 - DETAILS OF APPLICANT
SECTION 2 - NATURE OF ESTABLISHMENT
SECTION 3 - BACKGROUND MUSIC
 Seating Capacity
Bar 1
Bar 2
Bar 3
Restaurant 1
Restaurant 2
Verandah
Hair Salon
Waiting Rooms
Lounge
Entrance/Foyer
Other
 Square Footage
Fitness Centre
Shops/Stores
Shopping Centre
Supermarket
Showrooms
Factory/Workshop
Ground Floor
First Floor
Second Floor
Other
 How many
How many employees is the music audible to?
How many weeks per year is the music audible to these employees?
How many hours per day is the music audible to these employees?
 Dance SchoolsStudiosGymnasiaFitness Centres
How many number of Classes Per Week?
How many Students per class?
 Cinema
Estimated Number of Presentations per annum
Average Attendance Per Presentation
SECTION 4 - Letting Rooms For Functions With Music
Dances, Seminars, Receptions
Letting Rooms
SECTION 5 -FILM/VIDEO SHOWS
SECTION 6 - RECORDED MUSIC FOR DANCING
Dine & Dance/Discotheque
 Admission Per DaySeating/Standing CapacityEstimated Annual Income
Mondays
$
$
Tuesdays
$
$
Wednesdays
$
$
Thursdays
$
$
Fridays
$
$
Saturdays
$
$
Sundays
$
$
SECTION 7 - LIVE PERFORMANCES
Vocalist, instrumentalist & other artist, including karaoke
 Admission Per DaySeating/Standing CapacityEstimated Annual Income
Mondays
$
$
Tuesdays
$
$
Wednesdays
$
$
Thursdays
$
$
Fridays
$
$
Saturdays
$
$
Sundays
$
$
SECTION 8 - CABARET PERFORMANCES
Recorded Music to Floor/Dance Shows
 Admission Per DaySeating/Standing CapacityEstimated Annual Income
Mondays
$
$
Tuesdays
$
$
Wednesdays
$
$
Thursdays
$
$
Fridays
$
$
Saturdays
$
$
Sundays
$
$
SECTION 9 - OCEAN-GOING VESSELS
 Name of VesselType of Music UsedSeating/Standing CapacityNumber of owner operated cruises per weekAve. number of owner operated cruises per yearNumber of chartered cruises per yearAdmission Fee
# 1
$
# 2
$
# 3
$
# 4
$
# 5
$
# 6
$
# 7
$
# 8
$
# 9
$
# 10
$

PLEASE CHECK INFORMATION SUBMITTED CAREFULLY BEFORE READING AND SIGNING THIS DECLARATION.

I DECLARE THAT THIS INFORMATION SUBMITTED ON THIS APPLICATION IS,TO THE BEST OF MY/OUR KNOWLEDGE, CORRECT.

Please note effective immediately

1. Persons signing contracts should provide photo identification

2. A copy of business incorporation certificates should be provided for verification. In the case of business names then the contracts should be in the name of the individual

3. Payments of over $5000 should be presented in the form of a draft